Emergency Medicine Point-of-Care (Focused) Ultrasound

The Dept of Emergency Medicine at POWH supports the use of focused bedside ultrasound to assist in the clinical care of our patients, in accordance with ACEM Policy P21 (updated July 2019).  All staff using POCUS are required to follow this Policy, as well  as ACEM guidelines on cleaning and disinfection of ultrasound transducers that are used for needle-based procedures (November 2018).

Trainees are able to gain instruction and experience in focused ultrasound examination, interpretation and clinical correlation in a number of ways:

Ultrasound Special Skills Term (six months in total – 3 months US, 3 months tertiary ED, up to two trainees per term)

This provides the most intensive focused ultrasound experience, as trainees are rostered for two protected ultrasound days per week, in conjunction with two clinical shifts, for the entire six month period.  Most of the ultrasound shifts are directly supervised by a dedicated “US Consultant”. 

During this six-month period, trainees are expected, at a minimum, to gain a solid foundation in the clinical use of focused ultrasound perform at least 200 focused ultrasound examinations, become credentialled in EFAST and AAA ultrasound, as well as gain a good understanding of FELS, and procedural US.  Most trainees go beyond this minimal requirement and gain credentialing (to either ACEM or CCPU standard) in BESL/FELS and a number of other modules eg Lung, Biliary.

The US trainees also participate in teaching their fellow-registrars, thus broadening the US skill base in the Department, and providing a pathway for formal credentialing (via ACEM or CCPU pathways) to trainees who are not able to undertake such a term.

The US trainees are also required to complete a QI project, in keeping with their areas of interest.

The US SST is supervised by Dr Irene Rotenko, CCPU (EFAST, AAA, BELS, Lung, Biliary), Clinical Lead in ED Ultrasound.

Additional US supervisors include Dr Bruce Way, Dr Alvaro Manovel, and Dr Bi Hua Kua (CCPU EFAST, AAA, BELS).  Trainees are also provided opportunities to spend training time in the Echocardiography lab, and with other sonographers and sonologists.

Participating in a formal credentialing process

All EM trainees are encouraged to undertake formal training in focused ultrasound imaging.  While basic courses are occasionally offered on an ad hoc basis, there is no formal timetable for these, so trainees may prefer to attend an external accredited course, then undertake their practical training at POWH. 

POCUS Cheat Sheets:

Useful Resources:

POWED US Manual (written and maintained by Dr Al Manovel)

This is an open access document that provides a brief overview of ED POCUS  and a bedside resource for many of the applications of ultrasound in emergency medicine (such as Pregnancy, Echo, Lung, Biliary, Renal, Ocular). Our registrars are encouraged to use this as a launchpad to broaden their ultrasound horizons. 

There are many online resources (mostly free of charge) with useful educational material including formal courses, useful tips, great cases, and anatomy and physics tutorials. These include:

  • ASUM (Information on CCPU and DDU, useful links, also contains early pregnancy ultrasound training online under ‘resources’ tab then ‘e-learning’)
  • NSW Emergency Care Institute (Educational material and additional website links) 
  • Criticalcare-sonography (produced by emergency physicians at Royal Prince Alfred & Nepean hospitals) 
  • Ultrasound Village (produced by emergency physicians at Fiona Stanley and Sir Charles Gairdner hospitals) 
  • University of Utah echo teaching
  • The American and European echo societies also have some free educational resources on their websites
  • EMUGs (Emergency Medicine Ultrasound Groups - NSW collaboration of emergency physicians interested in ultrasound - blog, education and links to conferences & courses)